Individual
MARK ROBERT TOLSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1250 S EVERGREEN ST, SHAWANO, WI 54166-3514
(715) 526-3107
Mailing address
1029 W HARRIS ST, APPLETON, WI 54914-3857
(920) 266-7437
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
434591
NBCOT
—
Enumeration date
07/19/2021
Last updated
07/19/2021
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